Medicare AEP Webinar Agenda:
Dave Baum
Ericka Mann
Butler Capital Advisors
dbaum@butlercapital.net
emann@butlercapital.net
800.357.3190
Overview of Medicare Parts A & B, Medicare Supplement Plans,
Prescription Drug plans, Medicare Advantage Plans, Group
Dental and Vision Plans
(Plans offered in all states)
** If you need technical assistance during today’s webinar
presentation, please call 800.357.3190 x210
Benefit Options for the Retirees of
the Automotive Industry
Presented by
B
UTLER
C
APITAL
A
DVISORS
Professionally Serving Your Financial Well Being
Dave Baum
B
utler
C
apital
A
dvisors
28350 Kensington Lane Suite 100
Perrysburg, Ohio 43551
419.243.9665
419.243.2695 Fax
Dave Baum
Professionally Serving Your Financial Well-Being
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Complete Employee Benefit Packages
Group I nsurance
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Health
•
Life / AD&D
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Long and short-term disability
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Long term care
•
Dental and Vision
•
Payroll deduction plans (Voluntary)
•
Benefits Consulting
•
Plan Administrative and section 125
Group Services
•
Communicate benefits to the employer
and the employees
•
Enroll all new employees into the plan(s)
•
Provide assistance with handling claims,
communications, and policies and procedures
•
Provide assistance regarding billing and
C.O.B.R.A. administration
•
Act as liaison between employer and the
insurance company or administrator
•
Provide proposals from multiple
insurance carriers at renewal to maintain
competitive pricing and benefits
•
Coordinate health insurance benefits with
other employer-provided benefits
Registered Representative, Securities offered through Cambridge Investment Research, Inc. a Broker/ Dealer, Member FINRA/ SIPC. Investment A dvisor Representative, Cambridge Investment Research A dvisors, Inc., a Registered Investment A dvisor. Butler
Capital A dvisors, Inc. and Cambridge are not affiliated..
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Retirement Planning
•
Retirement Income Analysis
•
Individual Retirement Accounts (IRA’s)
•
Roth IRA’s
Education Planning
•
Education IRA
•
529 Plans (Education Savings Plan)
Estate Planning
•
Comprehensive Estate and Wealth
Transfer Planning
•
Succession Planning
•
Trust Consultation
•
Family Owned Business Planning
Wealth Building
•
Stocks*, Bonds*, Mutual Funds*, REITs*
•
Life Insurance Planning
(Variable*, Universal, Ordinary, Term)
•
Disability Income Insurance
•
Long Term Care Insurance
•
Annuities* (Variable, Fixed, Index)
Property & Casualty I nsurance
•
Home / Auto / Commercial
Qualified Plans
•
Plan Design and Consulting
•
401(k), 403(b), 457 plans
•
Pension / Profit Sharing
N onqualified Plans
•
Plan Design and Consulting
•
Deferred Compensation
•
Salary Continuation
Business Succession Planning
•
Business Overhead – Life/ Disability
•
Key Employee – Life/ Disability
Medicare is health insurance for the following:
People age 65 or older
People under age 65 with certain disabilities
People of any age with End-Stage Renal Disease (ESRD)
(permanent kidney failure requiring dialysis or a kidney
transplant)
Medicare consists of three parts ( Part A and B 1965, Part D 2006)
•
Part A
– Covers Facility Expenses , automatically enrolled
−
Hospitals, Skilled Nursing Facilities, Hospice
•
Part B
– Covers Medical Expenses, optional must enroll
−
Doctors and Therapists
−
Outpatient Surgery
−
X- Rays and Laboratory
−
Durable Medical Equipment
−
Preventative Services
•
Part D
– Prescription Drug Program, optional must enroll
Part A is automatic and typically free if you or your spouse paid
Medicare taxes while working. In 2014, people who had to buy
Part A paid up to $426 each month.
Hospital Facility:
−
First 60 days Medicare pays all but $1,216 of approved hospital
charges.
−
61 thru 90 days you pay $304 per day
−
91 thru 150 days you pay $608 per day
−
Beyond 150 days Medicare pays $0
Skilled Nursing Facility:
− First 20 days Medicare pays all approved charges
− 21 thru 100 days Medicare pays all but $152 per day
− Beyond 100 days Medicare pays $0
Medigap or Advantage programs may cover most of the charges above
Medicare Part B
Part B Covers Professional Fees
•
Person is eligible when they are 65 and requires enrollment, for
some, this is automatic
•
Part B requires payment of Premium; taken from Soc Sec Check
−
Standard Premium in 2014 is $104.90
−
If income is over $85,000 premium will be higher.
Your Yearly Income in 2011
File Individual Tax Return
File Joint Tax Return
You Pay a Part B
Premium of
$85,001 - $107,000
$170,001 - $214,000
$146.90
$107,001 - $160,000 $214,001 - $320,000
$209.80
$160,001 - $214,000 $320,001 - $428,000
$272.70
Medical Services
−
Senior pays first $147 of approved amounts (deductible)
−
Remainder of Medicare approved amounts
Medicare pays 80%
Senior pays 20%
−
Excess Charges above Medicare approved amounts
Up to 15% - Medicare pays 0% , Senior pays 100%
1. Deductible
−
Up to $320
2.
Initial Coverage Limit of $2,960
−
This is split between insurance company (75%) and
retiree (25%).
−
Retiree portion usually is co pays.
3.
Coverage gap
−
Retiree pays all Rx cost above $2,960
−
65% of Generic Cost
−
45% of certain covered Brand and Non Preferred
Prescriptions
* Many plans cover generics in coverage gap with
co pays
**
Some group plans cover brand and non preferred
brand in the coverage gap
4. Catastrophic Coverage
−
Once a retiree total drug costs reach $4,700,
drug costs become the greater of $2.65 for Generic,
$6.60 for Brand name OR 5% of the total drug cost
Part B:
The late enrollment penalty
is 10% (of the standard Part B
premium $104.90) for each
12-month period that enrollment is
delayed when first eligible to join
Medicare Part B.
Part D:
The late enrollment penalty
is 1% (of the average Part D
premium $30.00) per month that
enrollment is delayed when first
eligible to join a Part D prescription
plan.
“Welcome to Medicare” Preventive Visit
(one time)
Yearly “Wellness” visit offered free of charge.
An opportunity for you and your doctor, or
other health care provider, to review your
health and talk about what you can do to stay
as healthy as you can.
Preventive Care Services –
free of charge
Colorectal Cancer Screenings
Breast Cancer Screenings (Mammogram)
Diabetes Screenings
Flu Shots
Prostate Cancer Screenings
Glaucoma Tests
Cardiovascular Screenings
And more….. (refer to list on page 3 of Medicare & You
Handbook)
In 2015, if coverage gap is reached, you will
receive a 45% discount when buying certain
Part D covered brand-name drugs.
(2014 discount was 47.5%)
Additional savings over the next 5 years until
Part D drugs no longer excluded as of
1/1/2013:
Barbiturates (for epilepsy, cancer, and chronic
mental health disorders)
You can switch to a Medicare Advantage Plan
(like an HMO or a PPO) or Medicare
Prescription Drug Plan that has a 5-star
rating at any time during the year. This
triggers a Special Election Period (SEP) to
change plans.
Learn about the new “Blue Button” on
www.MyMedicare.gov
that you can use to
access your Medicare claims and other
Timeframe
Event
Late September 2014
•
Plan Annual Notice of Change (ANOC) letters will be mailed to members
to notify of any plan changes for upcoming year.
Early October 2014
•
Members will be notified if their plan will be eliminated for 2015.
October 1, 2014 –
October 14, 2014
•
Benefit and premium information becomes available for 2015 for all
Medicare Plans
•
Start to compare your coverage options
October 2014
•
Information seminars and webinars will be held at various locations
October 15, 2014 –
December 7, 2014
•
Medicare Annual Election Period (AEP)
•
If eligible, Medicare beneficiaries can enroll in a 2015 Medicare health
plan and/or prescription drug plan
January 1, 2015 –
March 1, 2015
•
Medicare General Enrollment Period (GEP)
•
Beneficiaries may enroll in Part B if did not enroll when first eligible
January 1, 2015 –
February 14, 2015
•
An individual enrolled in a Medicare Advantage Plan (Part C) may return
to Original Medicare and a stand-alone Part D plan during the first 45
days of the year.
April 1, 2015 –
December 31, 2015
•
“Lock-In” Period
•
Must stick with your current plan unless special circumstances arise (i.e.
you move)
General Enrollment Period Timeline for Medicare and NCRO Members
***Start planning now for the changes to come. Do not put off thinking about your
choices regarding your healthcare needs!
Chrysler
Medicare
Retiree
2-3 months prior to
65
th
birthday, Chrysler
sends notice to retiree
that coverage through
group plan will end July
1, 2014.
3 months prior to
Medicare eligibility,
Medicare sends Initial
Enrollment
Questionnaire (IEQ).
Complete Medicare
Initial Enrollment
Questionnaire (IEQ) and
return to Medicare.
Enroll in Part A and B
effective July 1, 2014.
Continue on Chrysler
group plan.
Medicare will mail red,
white and blue
Medicare card to
retiree.
Review Medicare
Insurance options (i.e.
MAPD, Medigap,
and/or PDP). Enroll in
plans selected.
Chrysler group benefits
end June 30, 2014.
Medicare coverage
begins July 1, 2014.
Coverage under
selected Medicare
plans begins (Medigap,
PDP, MAPD, etc.)
Annually review MAPD and/or PDP plans during
the Annual Election Period (AEP) for January 1
Chrysler
Medicare
Retiree
2-3 months prior to
65
th
birthday, Chrysler
sends notice to retiree
that coverage through
group plan will end July
1, 2014.
3 months prior to
Medicare eligibility,
Medicare sends Initial
Enrollment
Questionnaire (IEQ).
Complete Medicare Initial
Enrollment Questionnaire
(IEQ) and return to
Medicare. Enroll in Part A
and B effective July 1,
2014.
Continue on Chrysler
group plan.
Medicare will mail red,
white and blue
Medicare card to
retiree.
Review Medicare
Insurance options (i.e.
MAPD, Medigap, and/or
PDP). Enroll in plans
selected.
Chrysler group benefits
end for Retiree only on
June 30, 2014.
Medicare coverage
begins July 1, 2014.
Coverage under selected
Medicare plans begins
(Medigap, PDP, MAPD,
etc.)
Annually review MAPD and/or PDP plans during the
Annual Election Period (AEP) for a January 1 effective date.
Chrysler
Medicare
Spouse
2-3 months prior to
65
th
birthday, Chrysler
sends notice to spouse
that coverage through
group plan will end
May 1, 2014.
3 months prior to
Medicare eligibility,
Medicare sends Initial
Enrollment
Questionnaire (IEQ) to
spouse.
Complete Medicare
Initial Enrollment
Questionnaire (IEQ) and
return to Medicare.
Enroll in Part A and B
effective May 1, 2014.
Continue on Chrysler
group plan.
Medicare will mail red,
white and blue
Medicare card to
spouse.
Review Medicare
Insurance options (i.e.
MAPD, Medigap, and/or
PDP). Enroll in plans
selected.
Chrysler group benefits
end for spouse only on
April 30, 2014.
Medicare coverage
begins May 1, 2014.
Coverage under
selected Medicare plans
begins (Medigap, PDP,
MAPD, etc.)
Annually review MAPD and/or PDP plans during the
Annual Election Period (AEP) for a January 1 effective
Once enrolled in Medicare Parts A & B, there are several
options to enroll in a policy to provide additional
coverage:
Medicare Supplement (Medigap) Plan
Stand-Alone Prescription Drug Plan (Part D)
Medicare Advantage Plan (Part C)
Combinations:
Medigap only
Medigap + Prescription Drug Plan*
Medicare Advantage (with or without drug coverage)*
Prescription Drug Plan only
Medicare Supplement plans pay AFTER Medicare
for Medicare approved services
Continue to pay for Medicare Part B
Plan benefits are standardized by Medicare. Plans
offered range from A-N
Medigap plans allow you to see any doctor, any
hospital, any state – no network restrictions. (As
long as provider accepts Medicare.)
Offered through private insurance companies
Guaranteed renewal each year
Medical coverage only (would chose separate
Prescription drug plans offered through
private insurance companies
Plan availability varies by state
Some Part D plans have pharmacy network
restrictions. Many plans now have Preferred
pharmacies.
Plan rates and benefits change each year, and
Medicare allows members to review and
change drug plans each year during the
Medicare Annual Election Period (AEP) as
needed
Medicare Advantage Plans (MA or MAPD) pay for
services INSTEAD of Medicare
Continue to pay Medicare Part B premium
(typically $104.90)
Plans can be in the form of an HMO, PPO, or
PFFS. Most have network restrictions
Most MA plans include prescription drug
coverage (known as MAPD plans)
Plan rates and benefits change each year, and
Medicare allows member to review and change
MA or MAPD plans during the Medicare Annual
Election Period (AEP) as needed
An insurance company can't refuse to sell you a Medigap policy in the following situations:
You have a guaranteed issue right if… You have the right to buy… You can/must apply for a Medigap policy…
1. Date the coverage ends NOTE: In this situation, state laws may vary.
If your former Medigap policy isn't available, you can buy a Medigap Plan A,B,C,F,K, or L that is sold in your state by any insurance company. #6: Your Medigap insurance company goes
bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
Medigap Plan A,B,C,F,K, or L that is sold in your state by any insurance company.
You must apply no later than 63 calendar days from the date your coverage ends. Medigap Plan A,B,C,F,K, or L that is sold
by any insurance company in your state or the state you are moving to.
You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 calendar days after your health care coverage ends.
#4: (Trial Right) You joined a Medicare Advantage Plan or PACE when you were first eligible for Medicare Part A at age 65, and within the first year of joining, you decide you want to switch to Original Medicare.
Any Medigap policy that is sold in your state by any insurance company.
#5: (Trial Right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time; you have been in the plan less than a year, and you want to switch back.
The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If it included drug coverage, you can still get that same policy, but without the drug coverage.
NOTE: Your rights may last for an extra 12 months under certain circumstances. If you have COBRA coverage, you can
either buy a Medigap policy right away or wait until the COBRA coverage ends.
You must apply no later than 63 calendar days after the latest of these three dates: 2. Date on the notice you get telling you that coverage is ending (if you get one)
3. Date on a claim denial, if this is the only way you know that your coverage ended
You must apply no later than 63 calendar days from the date your coverage ends. #7: You leave a Medicare Advantage Plan or
drop a Medigap policy because the company hasn't followed the rules, or it misled you.
Medigap Plan A,B,C,F,K, or L that is sold in your state by any insurance company.
You can apply up to 60 calendar days before the date your coverage will end. You must apply no later than 63 calendar days after your coverage ends.
#3: You have Original Medicare and a Medicare SELECT policy. You move out the Medicare SELECT policy's service area.
You can keep your Medigap policy or you may want to switch to another Medigap policy. #1: You are in a Medicare Advantage Plan (MA Plan), and your plan is leaving Medicare or stops giving care in your area, or you moved out of the plan's service area.
You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 calendar days after your health care coverage ends.
Medigap Plan A,B,C,F,K, or L that is sold in your state by any insurance company. You only have this right if you switch to Original Medicare rather than joining another MA Plan.
NOTE: If you immediately join another MA Plan, you can stay in that plan for up to 1 year and still have the rights in situations #4 and #5.
** NOTE: Each insurance company has its own underwriting guidelines pertaining to pre-existing conditions. It is advised to check with the insurance company to determine if pre-existing limitations apply before you enroll, or attempt to make a change to your current plan.
You can apply up to 60 calendar days before the date your coverage will end. You must apply no later than 63 calendar days after your coverage ends.
NOTE: Your rights may last for an extra 12 months under certain circumstances. #2: You have Original Medicare and an
employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays. That coverage is ending.
Medigap Plan A,B,C,F,K, or L that is sold in your state by any insurance company.
Medicare Advantage Helpful Hints
You can join, switch, or drop Medicare Advantage Plans at these times:
•
When you first become eligible for Medicare
o
This is the 7 month period that begins 3 months before the month you turn
age 65, and ends 3 months after the month you turn age 65.
•
Annual Election Period (between October 15 – December 7 each year)
o
During this time beneficiaries may change prescription drug plans, change
Medicare Advantage plans, return to original Medicare, or enroll in a
Medicare Advantage plan for the first time.
o
Coverage will begin on January 1 of the following year. (However, see
section below on eligibility to change plans.)
•
In most cases, you must stay enrolled for that calendar year starting the date your
coverage begins. However, in certain situations, you may be able to join, switch,
or drop a Medicare Advantage Plan at other times. Some of these situations
include the following:
o
If you move out of your plan’s service area
o
If you have both Medicare and Medicaid
o
If you qualify for Extra Help to pay for your prescription drug costs
o
If you live in an institution (like a nursing home)
o
If your plan decides not to participate in Medicare
This is a summary of information provided in the “Medicare and You – 2012” booklet,
page 70. See this booklet for complete details.
** NOTE: Each insurance company has its own underwriting guidelines pertaining to
pre-existing conditions. It is advised to check with the insurance company to determine
if pre-existing limitations apply before you enroll, or attempt to make a change to your
current plan.
Where Do I Start?
Questionnaire
Scope of Sales
Appointment
Form
Where Do I
Start?
Questionnaire
Scope of
Sales
Appointment
Form
o
AARP/United Healthcare
o
Aetna
o
Aflac
o
American Continental / Continental Life
o
Anthem / BlueCross BlueShield
o
Assured Life
o
CIGNA
o
Coventry / Advantra / First Health Part D
o
Forethought
o
Gerber Life
o
Humana
o
Medical Mutual of Ohio
o
Mutual/United of Omaha
o
Paramount
o
Priority Health
o
SilverScript
o
Wellcare
o
And more…
Outline of Medicare Supplement Coverage
This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make available Plan "A." Some plans may not be
available in your state. See Outlines of Coverage sections for details about ALL plans. Plans E,H,I, and J are no longer available for sale.
BASIC BENEFITS
Hospitalization:
Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
Medical Expenses:
Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services.
Plans K, L, and N require insured's to pay a portion of Part B coinsurance or copayments.
Blood:
First 3 pints of blood each year.
Hospice:
Part A coinsurance.
Plan A
Plan B
Plan C
Plan D
Plan F Plan F*
Plan G
Plan K
Plan L
Plan M
Plan N
Basic,
including
100% Part B
coinsurance
Basic,
including
100% Part B
coinsurance
Basic,
including
100% Part B
coinsurance
Basic,
including
100% Part B
coinsurance
Basic, including
100% Part B
coinsurance
Basic,
including
100% Part B
coinsurance
Hospitalization
and preventive
care paid at
100%; other
basic benefits
paid at 50%
Hospitalization
and preventive
care paid at
100%; other
basic benefits
paid at 75%
Basic,
including
100% Part B
coinsurance
Basic, including 100%
Part B coinsurance,
except up to $20
copayment for office
visit, and up to $50
copayment for ER
Skilled
Nursing
Facility
coinsurance
Skilled
Nursing
Facility
coinsurance
Skilled Nursing
Facility
coinsurance
Skilled
Nursing
Facility
coinsurance
50% Skilled
Nursing Facility
coinsurance
75% Skilled
Nursing Facility
coinsurance
Skilled
Nursing
Facility
coinsurance
Skilled Nursing
Facility coinsurance
Part A
Deductible
Part A
Deductible
Part A
Deductible
Part A
Deductible
Part A
Deductible
50% Part A
Deductible
75% Part A
Deductible
50% Part A
Deductible
Part A Deductible
Part B
Deductible
Part B
Deductible
Part B Excess
(100%)
Part B
Excess
(100%)
Foreign Travel
Emergency
Foreign Travel
Emergency
Foreign Travel
Emergency
Foreign
Travel
Emergency
Foreign Travel
Emergency
Foreign Travel
Emergency
Out-of-pocket
limit $4,620;
paid at 100%
after limit
reached
Out-of-pocket
limit $2,310;
paid at 100%
after limit
reached
*
Plan F also has an option called a high deductible Plan F. The high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,070 deductible. Benefits
from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,070. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by
the policy/certificate. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plans' separate foreign travel emergency deductible.
(D.O.B.)
(State)
Plan A
Plan C
Plan F
Plan N
Company A
Company B
Company C
Company D
Company E
Company F
Company G
Company H
Medicare Supplement Rates Effective 1/1/2015
Monthly Premium
(Name)
Medicare Plan Finder
Plan Comparison - Drug Costs and Coverage
Note: The drug costs displayed are only estimates and actual costs may vary based on the specific quantity, strength and/or dosage of the drug, the order in which you buy your prescriptions, and the pharmacy you use.Your Search Details Zipcode: 43551
Current Plan: New To Medicare Current Subsidy: No Extra Help Drug List ID: 4228980736 Password Date: 1/15/1947
Your Drug Information
Drug Name Quantity Frequency Brand / Generic Original Drug Entry
Actonel TAB 35MG 4 Every 1 Month Brand Actonel Lipitor TAB 10MG 30 Every 1 Month Brand Lipitor Lisinopril TAB 10MG 30 Every 1 Month Generic Lisinopril Simvastatin TAB
20MG 30 Every 1 Month Generic Simvastatin
Aetna CVS/pharmacy
Prescription Drug Plan (PDP) AARP MedicareRx Preferred (PDP)
Humana Walmart-Preferred Rx Plan (PDP) S5810-048 S5820-013 S5884-137 Members: 1-877-238-6211 1-888-760-4748 (TTY/TDD) Non-Members: 1-800-832-2640 1-888-760-4748 (TTY/TDD) Plan Website:www.aetnamedicare.com Members: 1-888-867-5575 711 (TTY/TDD) Non-Members: 1-888-867-5564 711 (TTY/TDD) Plan Website:www.AARPMedicareRx.com Members: 1-800-281-6918 711 (TTY/TDD) Non-Members: 1-800-706-0872 711 (TTY/TDD) Plan Website: www.humana-Aetna CVS/pharmacy
Prescription Drug Plan (PDP) AARP MedicareRx Preferred (PDP)
Humana Walmart-Preferred Rx Plan (PDP) S5810-048 S5820-013 S5884-137 Members: 1-877-238-6211 1-888-760-4748 (TTY/TDD) Non-Members: 1-800-832-2640 1-888-760-4748 (TTY/TDD) Plan Website:www.aetnamedicare.com Members: 1-888-867-5575 711 (TTY/TDD) Non-Members: 1-888-867-5564 711 (TTY/TDD) Plan Website:www.AARPMedicareRx.com Members: 1-800-281-6918 711 (TTY/TDD) Non-Members: 1-800-706-0872 711 (TTY/TDD) Plan Website: www.humana-medicare.com
Drug Coverage Information Actonel TAB 35MG Tier: 33 Quantity Limit Tier: 33 Quantity Limit Tier: 43 Quantity Limit
Lipitor TAB 10MG Tier: 3
3 Quantity Limit Tier: 33 Quantity Limit Tier: 33 Quantity Limit Lisinopril TAB 10MG Tier: 1 No restrictions Tier: 1 No restrictions Tier: 1 No restrictions Simvastatin TAB 20MG Tier: 13 Quantity Limit Tier: 1 No restrictions Tier: 23 Quantity Limit Fixed Costs Monthly Premium $26.00 $34.80 $15.10 Annual Drug Deductible $320.00 $0.00 $320.00 Estimated Annual Drug Costs at Retail Pharmacy
January
